Treatment of Facial Asymmetry Using Distraction Osteogenesis in a Mandible First Approach.
Journal
Plastic and reconstructive surgery. Global open
ISSN: 2169-7574
Titre abrégé: Plast Reconstr Surg Glob Open
Pays: United States
ID NLM: 101622231
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
15
08
2022
accepted:
21
07
2023
medline:
22
9
2023
pubmed:
22
9
2023
entrez:
22
9
2023
Statut:
epublish
Résumé
Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage. Eighteen patients 14-25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required. Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months. The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14-18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.
Sections du résumé
Background
UNASSIGNED
Facial asymmetry includes several etiologies, among them trauma to the condylar area during early childhood and congenital malformations such as hemifacial microsomia. This article describes the management of facial asymmetry in adolescents and young adults using a mandible first approach by distraction osteogenesis, followed by maxillary Le-Fort I as a second stage.
Methods
UNASSIGNED
Eighteen patients 14-25 years of age presented with unilateral hypoplasia of the jaws which manifested clinically by deviation of the chin and canting of the occlusal plane. Etiology included hemifacial microsomia and trauma injuries at early childhood.All patients underwent orthodontic treatment and two phases of surgical treatment. Surgical treatment included unilateral mandibular distraction followed by Le-Fort I osteotomy for alignment of the maxilla. Additional bone graft in the affected side and sliding genioplasty were done as required.
Results
UNASSIGNED
Marked ramal elongation of 18.94 mm concomitant with mandibular forward traction of 12.5 mm was noted while achieving symmetry. In all cases, the maxilla was centered to the midline in proper occlusion. Post distraction, posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus, improvement in facial symmetry, and correction of the occlusal canting. Relapse was minimal based on long-term follow-ups of 47.4 months.
Conclusions
UNASSIGNED
The two-stage surgical approach that includes elongation of the mandible as a first stage followed by adaptation of the maxilla is useful in correcting facial asymmetry. Using this protocol at the correct age (14-18) is very stable, as demonstrated by our results, yet one should always remember the transverse deficiency in the gonial angle requires additional bone grafting or patient specific implants.
Identifiants
pubmed: 37736071
doi: 10.1097/GOX.0000000000005255
pmc: PMC10511035
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e5255Informations de copyright
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
The authors have no financial interest to declare in relation to the content of this article.
Références
J Craniofac Surg. 1997 Sep;8(5):422-30
pubmed: 9482086
Plast Reconstr Surg. 1992 Jan;89(1):1-8; discussion 9-10
pubmed: 1727238
Craniomaxillofac Trauma Reconstr. 2009 May;2(2):91-101
pubmed: 22110802
J Oral Maxillofac Surg. 2007 Apr;65(4):753-7
pubmed: 17368374
Plast Reconstr Surg. 2000 Feb;105(2):492-8
pubmed: 10697151
Ann Surg. 1979 Sep;190(3):320-31
pubmed: 485606
Ann Plast Surg. 2000 Oct;45(4):386-94
pubmed: 11037159
Acta Chir Plast. 1980;22(1):32-41
pubmed: 6157279
Ann Maxillofac Surg. 2017 Jan-Jun;7(1):64-72
pubmed: 28713738
Cleft Palate J. 1981 Apr;18(2):90-9
pubmed: 6939510
J Craniomaxillofac Surg. 2017 Jun;45(6):1031-1038
pubmed: 28457824
Int J Oral Maxillofac Surg. 1999 Feb;28(1):2-8
pubmed: 10065640
Plast Reconstr Surg. 1988 Jul;82(1):9-19
pubmed: 3289066
Am J Orthod. 1983 Sep;84(3):231-47
pubmed: 6577796
Plast Reconstr Surg. 1996 Feb;97(2):354-63
pubmed: 8559818
J Oral Maxillofac Surg. 2001 Jul;59(7):728-33
pubmed: 11429728
Br J Oral Maxillofac Surg. 2017 Jan;55(1):102-104
pubmed: 27262174
Clin Plast Surg. 1987 Jan;14(1):91-100
pubmed: 3816041
J Maxillofac Surg. 1974 Aug;2(2-3):73-92
pubmed: 4533024
J Craniomaxillofac Surg. 2011 Dec;39(8):549-53
pubmed: 21195627
Bull Hosp Jt Dis Orthop Inst. 1988 Spring;48(1):1-11
pubmed: 2840141
J Oral Maxillofac Surg. 1995 Jul;53(7):838-46
pubmed: 7595803
Int J Oral Maxillofac Surg. 2014 Oct;43(10):1176-81
pubmed: 25052572
J Craniomaxillofac Surg. 2012 Feb;40(2):105-11
pubmed: 21454084